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The optimal blood pressure targets for patients are still uncertain. The aim of this meta-analysis is to investigate current evidence from randomized controlled trials to establish new improvement.
We searched in Medline, Embase, Cochrane databases, and proceedings of major international meetings for large randomized controlled trials that comparing different blood pressure targets. We conducted the search from 2010 to 2015. Two independent reviewers reviewed the titles, abstracts and collected the data from studies that met the inclusion criteria. Conflicts between reviewers were resolved by consensus. We extracted study duration, patient characteristics and clinical outcomes. Blood pressure targets were divided into two groups in each study as the intensive treatment group and the standard treatment group. Internal validity of randomized controlled trials was assessed. The primary efficacy and safety outcomes were myocardial infarction, stroke, cardiovascular mortality, all cause mortality, hypotension and acute renal injury respectively. Odds ratios(OR) and 95% confidence interval(CI) were used as the summary statistic. Random-effects model was used for this meta-analysis.
We identified three large trial published between 2010 and 2015, including the Action to Control Cardiovascular Risk in Diabetes Study(ACCORD-BP), the Secondary Prevention of Small Subcortical Strokes(SPS3) and the Systolic Blood Pressure Intervention Trial(SPRINT) studies. Of 17115 patients from three large randomized controlled tries, it was indicated that intensive treatment had a better performance than standard treatment in myocardial infarction(OR: 0.86; 95% CI: 0.72-1.01; p=0.07). Meanwhile, it was showed that there were less stroke events with intensive treatment(OR: 0.77; 95% CI: 0.62-0.96; p=0.02). We noticed a trend towards favoring intensive treatment for cardiovascular mortality(OR: 0.81; 95% CI:0.56-1.17;p=0.26). However, we found no statistically significant difference in all cause mortality(OR: 0.93; 95% CI:0.72-1.20;p=0.55). As the safe outcome was concerned, intensive treatment had a higher rate with hypotension(OR: 2.04; 95% CI: 1.06-3.91; p=0.03).
In broad terms, it is indicated that intensive treatment is associated with significantly lower rates of stroke. Second, there is no significant difference in all cause mortality and cardiovascular mortality between intensive treatment and standard treatment. Third, patients with intensive treatment has significantly higher rate of hypotension which should raise out alert. Establishing the optimum goal of the blood pressure is crucial for the abundant hypertensive patients, current data is somehow limited. Therefore, further studies are required to clarify the key elements in different kinds of patients with hypertension balancing the benefit and the risk profile. As clinical practice is concerned so far, we should always remember to individualize the treatment for each patient.